Provider Demographics
NPI:1700881075
Name:ROSEN, RICHARD GARY
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GARY
Last Name:ROSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4064
Mailing Address - Country:US
Mailing Address - Phone:718-788-3168
Mailing Address - Fax:718-832-8729
Practice Address - Street 1:328 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4064
Practice Address - Country:US
Practice Address - Phone:718-788-3168
Practice Address - Fax:718-832-8729
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037060-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist